Think Twice About That Antibiotic

Antibiotic prescriptions for children leveled off over past decade

(RxWiki News) The large amount of antibiotic use in the past several decades has led to a new problem with antibiotic-resistant bacteria. Decreasing antibiotic use is an important step to address the new problem.

However, a recent study found that declines in antibiotic prescribing for children have slowed down. Some decreasing trends have even reversed, with the study authors finding increases in antibiotic prescriptions for children's ear infections.

The stabilization of antibiotic prescribing rates mean that doctors need to seek new ways to decrease the use of these medications.

"Ask your pediatrician if antibiotics are really needed."

The study, led by Louise Elaine Vaz, MD, of the Division of Infectious Diseases at Boston Children's Hospital, looked at trends in antibiotic use for children over the past decade.

Antibiotic rates had been declining for two decades, so researchers focused on how they may have changed more recently, between September 2000 and August 2010.

The researchers analyzed medical records during that time for all antibiotic prescriptions written for children aged 3 months to 18 years old at three different health care plans. The three health plans were located in New England, the Mountain West and the Midwest in the US.

There were already significant differences in the prescription rates across these three plans at the start of the study in 2000. One plan had an average of 2.3 antibiotic prescriptions per child per year, another had an average of 1.4, and the last had an average of 2.2 per child per year.

Overall, the authors found that the trend of decreasing antibiotic use slowed down considerably, or even stopped for some groups, during the ten years studied.

In the first part of the decade, antibiotic prescriptions declined anywhere from 5 percent to 9.3 percent per year across the three plans for children aged 3 to 24 months old. By the end of the decade, however, the declines each year across the plans ranged from 0.5 percent to 2.4 percent.

In fact, when it came to the specific condition of ear infections in young children, the use of antibiotics actually started to increase during this time.

One health plan saw antibiotic prescribing for ear infections increase 1.6 times, one increased 5.5 times, and another increased by 15 times the earlier decade's rates.

The researchers also found that more broad-spectrum antibiotics were being used in older age groups. Broad-spectrum antibiotics kill off a wide variety of bacteria, but they are also more likely to lead to antibiotic-resistant bacteria.

The authors suggested that best practices need to be identified to find ways to jumpstart the decline in antibiotic use again.

They also emphasized the importance of decreasing broad-spectrum antibiotic use unless absolutely necessary.

Thomas Seman, MD,  a pediatrician at North Shore Pediatrics in Danvers, Mass. who was not involved with the study, noted the challenges in changing medical providers' culture in thinking carefully about to prescribe antibiotics or not.

"Educating the patient and, in pediatrics, the parents about what antibiotics can and cannot do takes considerable time in some cases but some added time in all cases," Dr. Seman said. "With the increased number of patients being seen lately, this extra time may not be taken in order to keep up with the schedule."

He was therefore not overly surprised that the decrease in prescribing antibiotics has started to lull.

"Complacency or fatigue, whatever the case, causes many of us to just give in to the parents' constant demand for 'something' to make the illness go away," he said. "Unfortunately, this is only breeding superbugs and a generation that may see worse infections."

The study was published February 3 in the journal Pediatrics. The research was funded by the National Institutes of Health. The authors declared no conflicts of interest.

Review Date: 
February 6, 2014